Provider Demographics
NPI:1851134258
Name:WHEELER, MARY HANNAH (OD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HANNAH
Last Name:WHEELER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CLIFTON GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3413
Mailing Address - Country:US
Mailing Address - Phone:912-286-0888
Mailing Address - Fax:
Practice Address - Street 1:12 FARMFIELD AVE STE C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7755
Practice Address - Country:US
Practice Address - Phone:843-890-8037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2490390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program